Humphries, David Madison

Humphries, David Madison is an individual health care provider with primary practice located at 1631 Sw Columbia St , Portland OR 97201-6025. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Other Service Providers / Peer Specialist. Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) is his primary health care specialty. Humphries, David Madison can be contacted via phone (503) 231-2641.

Contact Information

Primary practice address
1631 Sw Columbia St Portland OR 97201-6025
Phone: (503) 231-2641
Fax: (503) 231-1654
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 17-CRM-II-011 Oregon
Other Service Providers / Peer Specialist 175T00000X THW0001269 Oregon
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 14-07-06 Oregon

Profile Details

NPI number 1184054710
LBN Legal business name Humphries, David Madison
Credentials CADC I/CRM II/PSS
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 18th, 2013
Last updated May 18th, 2023 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1184054710 NPPES
Oregon MEDICAID 500730604
Oregon MEDICAID 500699779

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